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C-reactive protein and red cell distribution width as indicators of complications in patients with acute appendicitis

Year 2019, Volume: 4 Issue: 2, 76 - 80, 01.08.2019
https://doi.org/10.25000/acem.546308

Abstract

Aim: Acute appendicitis is one of the most common operations in general
surgery. When complicated, mortality and morbidity increases. We aimed to find
out whether use of C-reactive protein (CRP) and red cell distribution width
(RDW) may help to find out development of complications with acute  appendicitis at initial evaluation in an
emergency department.

Methods: Files of the patients who underwent operations for acute
appendicitis between January 2017 and August 2017 were reviewed. Development of
complications was recorded and the patients were grouped as with and without
complications and were compared about age, sex RDW, CRP, alanine
aminotransferase (ALT) and aspartate aminotransferase (AST) levels. Diagnostic
efficiency of CRP and RDW on the development of complications in acute
appendicitis was investigated with regression analysis and by receiver operator
characteristic curve analysis.

Results: Age, CRP and RDW were found to be significantly related to
perforation (p<0.001 for all) (Bonferoni correction), while white blood cell
(WBC), AST and ALT were found to be insignificant (p=0.052, p=0.806 and
p=0.804, respectively.
There was a significant correlation between
RDW and CRP in the Spearman non-parametric correlation analysis (correlation
coefficient r=0.244 and p<0.001).
There was no significant correlation of WBC to CRP and RDW.







Conclusion:
CRP and RDW are biochemical parameters that help us to identify the development
of complications in acute appencitis. CRP may be elevated in acute
appendicitis; however, it must be kept in mind to be cautious about a
potentially complicated acute appendicitis after a certain level, RDW in our
study has been found to be elevated in complicated appendicitis cases; but,
it  may not helpful to detect for
perforated or gangrenous appendicitis.

References

  • 1. Mentes O, Eryılmaz M, Harlak A, Yaman H, Yıgıt T, Ongoru O, et al. The importance of urine 5-hydroxyindoleacetic acid levels in the early diagnosis of acute appendicitis. Am J Emerg Med. 2009;27:409-12.
  • 2. Ma KW, Chia NH, Yeung HW, Cheung MT. If not appendicitis, then what else can it be? A retrospective review of 1492 appendectomies. Hong Kong Med J. 2010;16:12-7.
  • 3. Gurleyik G, Gurleyik E, Cetinkaya F, Unalmiser S. Serum interleukin-6 measurement in the diagnosis of acute appendicitis. ANZ J Surg. 2002;72:665-7.
  • 4. Petroianu A. Diagnosis of acute appendicitis. Int J Surg. 2012;10:115-9.
  • 5. Jaffe BM, Berger DH. The appendix. Schwartz’s Principles of Surgery. 9th ed. New York: McGraw Hill; 2010. pp. 1073–91.
  • 6. Sproston NR, Ashworth JJ. Role of C-Reactive Protein at Sites of Inflammation and Infection. Front Immunol. 2018;9:754.
  • 7. Szalai AJ, van Ginkel FW, Dalrymple SA, Murray R, McGhee JR, Volankis JE. Testosterone and IL-6 requirements for human C-reactive protein gene expression in transgenic mice. J Immunol. 1998;160:5294–9.
  • 8. Du Clos TW, Mold C. C-reactive protein: an activator of innate immunity and a modulator of adaptive immunity. Immunol Res. 2004;30:261–77.
  • 9. Gurleyik E, Gurleyik G, Unalmişer S. Accuracy of serum C-reactive protein measurements in diagnosis of acute appendicitis compared with surgeon's clinical impression. Dis Colon Rectum. 1995:1270–4.
  • 10. Lippi G, Targher G, Montagnana M, Salvagno GL, Zoppini G, Guidi GC. Relation between red blood cell distribution width and inflammatory biomarkers in a large cohort of unselected outpatients. Arch Pathol Lab Med. 2009;133:628–32.
  • 11. Hunziker S, Celi LA, Lee J, Howell MD. Red cell distribution width improves the simplified acute physiology score for risk prediction in unselected critically ill patients. Crit Care. 2012;16:R89.
  • 12. Subhashree AR, Shanthi B, Parameaswari PJ. The Red Cell Distribution Width as a Sensitive Biomarker for Assessing the Pulmonary Function in Automobile Welders- A Cross Sectional Study. J Clin Diagn Res. 2013;7:89–92.
  • 13. Dinc T, Senol K, Yildiz B, Kayilioglu I, Sozen I, Coskun F. Association between red cell distribution width and mean platelet volume with appendicitis: a myth or a fact? Bratisl Lek Listy. 2015;116:499–501.
  • 14. Clavien PA, Sanabria JR, Strasberg SM. Proposed classification of complications of surgery with examples of utility in cholecystectomy. Surgery. 1992;111:518-26.
  • 15. Pittman-Waller VA, Myers JG, Stewart RM, Dent DL, Page CP, Gray GA, et al. Appendicitis: why so complicated? Analysis of 5755 consecutive appendectomies. Am Surg. 2000;66:548–54.
  • 16. Berry J, Jr, Malt RA. Appendicitis near its centenary. Ann Surg. 1984;200:567–75.
  • 17. Kim SH, Park SJ, Park YY, Choi SI. Delayed Appendectomy Is Safe in Patients With Acute Nonperforated Appendicitis. Int Surg. 2015;100:1004–10.
  • 18. Giraudo G, Baracchi F, Pellegrino L, Dal Corso HM, Borghi F. Prompt or delayed appendectomy? Influence of timing of surgery for acute appendicitis. Surg Today. 2013;43:392–6.
  • 19. Earley AS, Pryor JP, Kim PK, Hedrick JH, Kurichi JE, Minogue AC, et al. An Acute Care Surgery Model Improves Outcomes in Patients With Appendicitis. Ann Surg. 2006:244:498–504.
  • 20. Ditillo MF, Dziura JD, Rabinovici R. Is it safe to delay appendectomy in adults with acute appendicitis? Ann Surg. 2006;244:656–60.
  • 21. Udgiri N, Curras E, Kella VK, Nagpal K, Cosgrove J. Appendicitis, is it an emergency? Am Surg. 2011;77:898–901.
  • 22. Yardeni D, Hirschl RB, Drongowski RA, Teitelbaum DH, Geiger JD, Coran AG. Delayed versus immediate surgery in acute appendicitis: do we need to operate during the night? J Pediatr Surg. 2004;39:464–9.
  • 23. Stahlfeld K, Hower J, Homitsky S, Madden J. Is acute appendicitis a surgical emergency? Am Surg. 2007;73:626–9.
  • 24. Eriksson S,Granström L. Randomized controlled trial of appendicectomy versus antibiotic therapy for acute appendicitis. Br J Surg. 1995:82:166–9.
  • 25. Styrud J, Eriksson S, Nilsson I, Ahlberg G, Haapaniemi S, Neovius G, et al. Appendectomy versus antibiotic treatment in acute appendicitis. a prospective multicenter randomized controlled trial. World J Surg. 2006;30:1033–7.
  • 26. Ortega-Deballon P, Ruiz de Adana-Belbel, JC, Hernández-Matías, A, García-Septie J, Moreno-Azcoita M. Usefulness of laboratory data in the management of right iliac fossa pain in adults. Dis Colon Rectum. 2008;51:1093–9.
  • 27. Sack U, Biereder B, Elouahidi T, Bauer K, Keller T, Tröbs RB. Diagnostic value of blood inflammatory markers for detection of acute appendicitis in children. BMC Surg. 2006;6:15.
  • 28. Xharra S, Gashi-Luci L, Xharra K, Veselaj F, Bicaj B, Sada F, et al. Correlation of serum C-reactive protein, white blood count and neutrophil percentage with histopathology findings in acute appendicitis. WJES. 2012;7:27.
  • 29. Yokoyama S, Takifuji K, Hotta T, Matsuda K, Nasu T, Nakamori M, et al. C-Reactive protein is an independent surgical indicationmarker for appendicitis: a retrospective study. World J Emerg Surg. 2009;31:36.
  • 30. Boshnak N, Boshnaq M, Elgohary H. Evaluation of Platelet Indices and Red Cell Distribution Width as New Biomarkers for the Diagnosis of Acute Appendicitis. J Invest Surg. 2018;31:121–9.
  • 31. Bozlu G, Taskinlar H, Unal S, Alakaya M, Nayci A, Kuyucu N. Diagnostic value of red blood cell distribution width in pediatric acute appendicitis. Pediatr Int. 2016;58:202-5.

Akut apandisit tanısı konmuş hastalarda komplikasyon belirteçleri olarak C-reaktif protein ve kırmızı küre dağılım indisinin yeri ve önemi

Year 2019, Volume: 4 Issue: 2, 76 - 80, 01.08.2019
https://doi.org/10.25000/acem.546308

Abstract

 Amaç: Akut apandisit genel cerrahide en sık
karşılaşılan operasyon sebeplerinden
 
biridir.  Komplike olduğu zaman
mortalite ve morbidite artmaktadır. C-reaktif protein (CRP) ve kırmızı küre
genişlik dağılım indisi (RDW) değerlerinin kullanılması komplike olan akut
apandisit vakalarını acil servisteki ilk muayenede ayırt etmemizde faydalı olup
olmadığını incelemeyi amaçladık.



Yöntemler: Ocak  2017 ve Ağustos 2017 tarihleri arasında akut
apandisit nedeniyle opere edilmiş olan hastaların dosyaları tarandı. Hastalar
yaş, cinsiyet, CRP, RDW, alanin aminotrasferaz, aspartat aminotransferaz
değerleri açısından komplike olan ve olmayan akut apandisit vakalarında
karşılaştırıldı. Artmış serum CRP ve RDW değerlerinin komplike apandisit tanısı
koymada ne kadar etkin olduğu regresyon analizi ve alıcı işlemci karakteristiği
eğrisi analizi ile değerlendirildi.



Bulgular: Yaş, RDW ve CRP, perforasyon ve
gangrenöz apandisit ile belirgin olarak ilişkili olarak bulundu, p<0,001,
beyaz küre, aspartat aminotransferaz (AST), alanin aminotransferaz (ALT)
düzeyleri ise P değerleri açısından anlamsız olarak bulundu (sırasıyla p=0,052,
p=0,806 ve p=0,804). RDW ile CRP arasında korelasyon olmakla birlikte
(korelasyon katsayısı r=0,244 ve p<0,001), beyaz küre ile RDW ve CRP arasında
anlamlı bir ilişki yoktu.



Sonuç: CRP ve RDW komplike
apandisit tanısını koymamızda biyokimsasal parametre olarak
değerlendirilmelidir. CRP akut apandisit vakalarında artmış olarak tespit
edilebilir ancak belli bir seviyeden sonra komplike olmuş bir apandisite işaret
edebilir. RDW bizim çalışmamızda komplike apandisitlerde artmış olarak bulundu.
Ancak bu yükseklik için bir eşik değer tespit edilemedi.

References

  • 1. Mentes O, Eryılmaz M, Harlak A, Yaman H, Yıgıt T, Ongoru O, et al. The importance of urine 5-hydroxyindoleacetic acid levels in the early diagnosis of acute appendicitis. Am J Emerg Med. 2009;27:409-12.
  • 2. Ma KW, Chia NH, Yeung HW, Cheung MT. If not appendicitis, then what else can it be? A retrospective review of 1492 appendectomies. Hong Kong Med J. 2010;16:12-7.
  • 3. Gurleyik G, Gurleyik E, Cetinkaya F, Unalmiser S. Serum interleukin-6 measurement in the diagnosis of acute appendicitis. ANZ J Surg. 2002;72:665-7.
  • 4. Petroianu A. Diagnosis of acute appendicitis. Int J Surg. 2012;10:115-9.
  • 5. Jaffe BM, Berger DH. The appendix. Schwartz’s Principles of Surgery. 9th ed. New York: McGraw Hill; 2010. pp. 1073–91.
  • 6. Sproston NR, Ashworth JJ. Role of C-Reactive Protein at Sites of Inflammation and Infection. Front Immunol. 2018;9:754.
  • 7. Szalai AJ, van Ginkel FW, Dalrymple SA, Murray R, McGhee JR, Volankis JE. Testosterone and IL-6 requirements for human C-reactive protein gene expression in transgenic mice. J Immunol. 1998;160:5294–9.
  • 8. Du Clos TW, Mold C. C-reactive protein: an activator of innate immunity and a modulator of adaptive immunity. Immunol Res. 2004;30:261–77.
  • 9. Gurleyik E, Gurleyik G, Unalmişer S. Accuracy of serum C-reactive protein measurements in diagnosis of acute appendicitis compared with surgeon's clinical impression. Dis Colon Rectum. 1995:1270–4.
  • 10. Lippi G, Targher G, Montagnana M, Salvagno GL, Zoppini G, Guidi GC. Relation between red blood cell distribution width and inflammatory biomarkers in a large cohort of unselected outpatients. Arch Pathol Lab Med. 2009;133:628–32.
  • 11. Hunziker S, Celi LA, Lee J, Howell MD. Red cell distribution width improves the simplified acute physiology score for risk prediction in unselected critically ill patients. Crit Care. 2012;16:R89.
  • 12. Subhashree AR, Shanthi B, Parameaswari PJ. The Red Cell Distribution Width as a Sensitive Biomarker for Assessing the Pulmonary Function in Automobile Welders- A Cross Sectional Study. J Clin Diagn Res. 2013;7:89–92.
  • 13. Dinc T, Senol K, Yildiz B, Kayilioglu I, Sozen I, Coskun F. Association between red cell distribution width and mean platelet volume with appendicitis: a myth or a fact? Bratisl Lek Listy. 2015;116:499–501.
  • 14. Clavien PA, Sanabria JR, Strasberg SM. Proposed classification of complications of surgery with examples of utility in cholecystectomy. Surgery. 1992;111:518-26.
  • 15. Pittman-Waller VA, Myers JG, Stewart RM, Dent DL, Page CP, Gray GA, et al. Appendicitis: why so complicated? Analysis of 5755 consecutive appendectomies. Am Surg. 2000;66:548–54.
  • 16. Berry J, Jr, Malt RA. Appendicitis near its centenary. Ann Surg. 1984;200:567–75.
  • 17. Kim SH, Park SJ, Park YY, Choi SI. Delayed Appendectomy Is Safe in Patients With Acute Nonperforated Appendicitis. Int Surg. 2015;100:1004–10.
  • 18. Giraudo G, Baracchi F, Pellegrino L, Dal Corso HM, Borghi F. Prompt or delayed appendectomy? Influence of timing of surgery for acute appendicitis. Surg Today. 2013;43:392–6.
  • 19. Earley AS, Pryor JP, Kim PK, Hedrick JH, Kurichi JE, Minogue AC, et al. An Acute Care Surgery Model Improves Outcomes in Patients With Appendicitis. Ann Surg. 2006:244:498–504.
  • 20. Ditillo MF, Dziura JD, Rabinovici R. Is it safe to delay appendectomy in adults with acute appendicitis? Ann Surg. 2006;244:656–60.
  • 21. Udgiri N, Curras E, Kella VK, Nagpal K, Cosgrove J. Appendicitis, is it an emergency? Am Surg. 2011;77:898–901.
  • 22. Yardeni D, Hirschl RB, Drongowski RA, Teitelbaum DH, Geiger JD, Coran AG. Delayed versus immediate surgery in acute appendicitis: do we need to operate during the night? J Pediatr Surg. 2004;39:464–9.
  • 23. Stahlfeld K, Hower J, Homitsky S, Madden J. Is acute appendicitis a surgical emergency? Am Surg. 2007;73:626–9.
  • 24. Eriksson S,Granström L. Randomized controlled trial of appendicectomy versus antibiotic therapy for acute appendicitis. Br J Surg. 1995:82:166–9.
  • 25. Styrud J, Eriksson S, Nilsson I, Ahlberg G, Haapaniemi S, Neovius G, et al. Appendectomy versus antibiotic treatment in acute appendicitis. a prospective multicenter randomized controlled trial. World J Surg. 2006;30:1033–7.
  • 26. Ortega-Deballon P, Ruiz de Adana-Belbel, JC, Hernández-Matías, A, García-Septie J, Moreno-Azcoita M. Usefulness of laboratory data in the management of right iliac fossa pain in adults. Dis Colon Rectum. 2008;51:1093–9.
  • 27. Sack U, Biereder B, Elouahidi T, Bauer K, Keller T, Tröbs RB. Diagnostic value of blood inflammatory markers for detection of acute appendicitis in children. BMC Surg. 2006;6:15.
  • 28. Xharra S, Gashi-Luci L, Xharra K, Veselaj F, Bicaj B, Sada F, et al. Correlation of serum C-reactive protein, white blood count and neutrophil percentage with histopathology findings in acute appendicitis. WJES. 2012;7:27.
  • 29. Yokoyama S, Takifuji K, Hotta T, Matsuda K, Nasu T, Nakamori M, et al. C-Reactive protein is an independent surgical indicationmarker for appendicitis: a retrospective study. World J Emerg Surg. 2009;31:36.
  • 30. Boshnak N, Boshnaq M, Elgohary H. Evaluation of Platelet Indices and Red Cell Distribution Width as New Biomarkers for the Diagnosis of Acute Appendicitis. J Invest Surg. 2018;31:121–9.
  • 31. Bozlu G, Taskinlar H, Unal S, Alakaya M, Nayci A, Kuyucu N. Diagnostic value of red blood cell distribution width in pediatric acute appendicitis. Pediatr Int. 2016;58:202-5.
There are 31 citations in total.

Details

Primary Language English
Subjects Surgery
Journal Section Original Research
Authors

Okan Murat Aktürk 0000-0002-0759-3756

Mikail Çakır This is me 0000-0001-8087-5680

Doğan Yıldırım This is me 0000-0003-2901-9971

Muzaffer Akıncı This is me 0000-0002-7068-6816

Publication Date August 1, 2019
Published in Issue Year 2019 Volume: 4 Issue: 2

Cite

Vancouver Aktürk OM, Çakır M, Yıldırım D, Akıncı M. C-reactive protein and red cell distribution width as indicators of complications in patients with acute appendicitis. Arch Clin Exp Med. 2019;4(2):76-80.